Autism is a wide-ranging condition about which there is still much to understand. It is more frequent in boys than in girls. A child with autism seldom attempts to communicate with others, either in words of bodily gestures. Their interests and activities are restricted and repetitive.
The abnormal behaviours associated with autism usually develop when the child is about a year old. They are all present by the time the child has reached their third birthday.
Despite a great deal of research in the past 30 years, the cause of autism is unknown. In the majority of cases there is no identifiable medical cause. However, it is generally accepted that children with autism suffer from a basic cognitive deficit. This means they have difficulty in developing knowledge and understanding of other people and the world in which they live.
Parents who believe their child may be autistic should seek a diagnosis as soon as possible. An experienced team of professionals (including a psychiatrist and a psychologist) will give a diagnosis which includes a full assessment of the child’s particular strengths and weaknesses.
The assessment will provide parents with a clearer understanding of their child's difficulties and give them useful information as to how they can help them. The assessment is also important in clarifying the kind of educational resources and schooling that will best meet the child's special needs.
The child will require support from speech therapists, educational psychologists and teachers, as well as their parents. It is important that they work together as a team, and communicate regularly, in order to help the child overcome their difficulties and make progress.
Preparing the ground
It is important to build a warm relationship with a child who is socially and emotionally withdrawn. These children may feel threatened when other people attempt to occupy their 'space', especially if they are relative strangers.
Gradually introduce them to objects or activities which they enjoy, such as musical activities or games like blowing bubbles. With growing familiarity, they are likely to accept the presence of those associated with pleasurable experiences.
Children need to be motivated. If they are going to make the effort to interact with others, they need to have a reason to communicate.
It can be rewarding for the child if they learn different ways of controlling their world. Set up situations in which the child can either choose or reject an object or activity. They can be offered a choice of two items and asked 'What do you want?' (stressing the word 'want').
To begin with, any slight indication of their choice is accepted. The target is for the child to learn the word 'want' and use it in the appropriate circumstances. Learning to say 'no' when they want to reject an object or activity is also of use to them. Other useful words for them to learn in a meaningful social context are 'more' and 'again'.
The child's difficulty in processing new information needs to be taken into account. It is helpful if the situation in which the activity takes place is familiar to them. This makes it easier for the child to focus their attention on the new item to be learned.
To help them learn, the activity needs to be presented in small steps. Where possible, the steps should follow an orderly sequence – e.g. when the small child is being dressed or bathed, the steps proceed in the same order each time. As the parent/professional names them, the child learns to recognise the sounds of the names of parts of their body or clothes. With adequate repetition, it is likely that the child will begin to use them meaningfully themselves.
This type of logical sequence, with a clear beginning and end, can be extended to small group activities including siblings or children in the playgroup. An activity such as pretending to go shopping with mum in the supermarket is an example of a 'joint action routine'. Each child has a recognised role and most nursery classes will have the props the children need.
This kind of activity provides a great opportunity for social interaction between the members of the group as well as a valuable context in which children can learn to use speech and language to communicate with others.
In this kind of structured group activity, children with autism learn to take turns with others, wait until their turn comes and respond to the speech and actions of others. They learn social skills and behaviours which increasingly enable them to join in activities with other children.
For language learning, it is important for the speech therapist to have assessed the child's receptive and expressive language skills. Parents and teachers can then be guided to provide the speech and language that is appropriate for the child's levels of development in the understanding of words and ability to produce and use them in communicating with others.
The parent/professional working with the child needs to remember to use short and simple sentences, with some stress on the words to be learnt. A fair amount of repetition is also needed. For the child, as long as the activity is fairly enjoyable, repetition is usually reassuring.
Repetition also allows the child to build up the associations between the objects or activities he is learning about, an essential part of 'knowledge' of the item. For example, the child's concept of water can be formed by allowing him to explore the characteristics of water - wash in it, drink it, pour it, etc.
This is extended to finding out where the water comes from, use of taps and perhaps collecting rain water in a bowl outside. Is the water hot or cold? In this way, the child is learning to use language which has meaning for him. He learns to use verbs while 'doing' the actions, to use adjectives (or describing words) when feeling the temperature of the water, and so on.
You might find the following two books about autism useful - 'Teaching young children with autistic spectrum disorders to learn: A practical guide for parents and staff in mainstream schools and nurseries' by Liz Hannah and 'Autism: the facts' by Dr Simon Baron-Cohen and Dr Patrick Bolton.